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Management of Semantics in
Structured Laboratory Report
Session 132, February 13, 2019
Arianna Cocchiglia, R&D Manager, Arsenàl.IT
Myriam Ferrari, Project Engineer, Arsenàl.IT
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Arianna Cocchiglia, R&D Manager
Myriam Ferrari, Project Engineer
Have no real or apparent conflicts of interest to report.
Conflict of Interest
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Background
HIE
Interoperability and focus on Lab Report
Semantics Interoperability
Management of Semantics
Barriers and suggestions
Numbers
Applications and... new challenges
Agenda
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Employ standards in data sharing and
interoperability
Design a working process to manage semantics
mapping activity
Describe the functionalities of a code system to
manage semantics
Learning Objectives
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Arsenàl.IT - Who we are
Background
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The Healthcare System - Veneto Region
Background
“I want to tell you a story…”
One regional public health system
Nine local health authorities (LHAs)
Two hospital trusts (HTs)
One oncology research center
and...
Twenty-three different Laboratories
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Veneto HIE System
Total number:
ePrescriptions: 121,586,123
eReferrals: 64,091,607
Radiology reports: 2,417,812
ER reports: 1,720,404
Discharge letters: 559,084
Outpatient visit reports: 493,224
Operative reports: 276,167
Lab reports: 6,507,119
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Veneto HIE System
Why?
Secondary
usage of data
...with readable and
machine-processable
data!
Lab report:
- High number of reports available
- High number of data contained in each report
- Relevant in control and prevention (AMR
surveillance, ACG, …)
CARE
GOVERNANCE
RESEARCH
HIE
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...and sharing means Interoperability
HIE system means, at first, sharing of eRecords...
Veneto HIE System
HIE
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Interoperability
Starting from
HIE
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Level 1
standard to share documents
Interoperability
HIE
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Level 2
standard to structure documents
Interoperability
Semantics
HIE
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Level 3
standard in language
HIE
Interoperability
Semantics
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Level 1:
IHE Cross-Enterprise document
sharing profile (XSD.b)
Level 2:
HL7 CDA
®
R2 Structured Clinical
Document
Level 3: standard codes...
Interoperability - Lab Report
How
HIE
HIE
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Local terminology are
dissimilar
Use of idiosyncratic local
codes
...the use of the same
language to define the same
concept
Interoperability - Lab Report
Semantic Interoperability
Emoglobina
glicata
Hemoglobina
glicosilada
Glycated
hemoglobin
HbA1c
Γλυκοζυλιωμέν
η αιμοσφαιρίνη
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Public
Globally adopted
“...LOINC fits perfectly as the vocabulary
standard for observation identifiers in
HL7 messages. In 2011, Regenstrief and
HL7 signed a statement of
understanding to enhance their long-
standing relationship to develop
complementary health data standards.”
Regenstrief/HL7 agreement (2011-11-29)
Interoperability - Lab Report
Semantic Interoperability
Standard code system LOINC
®
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Local codes
Semantic Interoperability
The mapping process
LOINC
®
codes
1,150 laboratory tests
15,168 local test results
4,046 LOINC
®
codes
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Semantic Interoperability
The mapping process
Local codes
LOINC
®
codes
HIE
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LHAs information system representatives
Clinicians and
laboratory technicians
Skillful support team
Semantic Interoperability
The multidisciplinary team
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Semantic Interoperability
The tool
Terminology Service
...to easily perform the transcoding
from local codes to LOINC
®
codes
Transcode
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co-workingbetween different Laboratories (suggestions from other
Labs regarding the same concept, sharing of work)
...to reduce erroneous mapping
...to accelerate mapping activity
Management of semantics
Terminology Service - main features
Show other Labs
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overlook of historical changes
...to better manage the work
Management of semantics
Terminology Service - main features
Restore
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most frequently performed lab tests are highlighted
...to have an order to perform transcoding
Management of semantics
Terminology Service - main features
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Semantic Interoperability
Getting started
Training about:
Terminology Service
LOINC
®
...to increase clinicians expertise
...to reduce the undesirable mapping results
Scheduling of activities:
cluster lab tests
starting from the most frequently performed
… to distribute the workload!
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continuous guidance, education and counseling
continuous engagement of clinicians
...to increase participation and motivation
cooperation and motivation
...to overcome the “barrier to change”
Semantic Interoperability
On the job actions
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Semantic Interoperability
On the job actions
suggestions
from a support team of expert
clinicians
...to facilitate the transcoding
info about progress of work
...to improve the activity growth
Progress of activities
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quality check
finding of potential erroneous mapping and suggestions
of possible correct codes
...to improve the quality of transcoding
...to enhance data quality
Semantic Interoperability
On the job actions
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...to have
semantic enrichment
of data!
Semantic Interoperability
On the job actions
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Laboratories periodical upload the mapped LOINC
®
codes in the LISs
Adoption of standard codes in HL7 CDA
®
R2
Laboratory Report
structured Laboratory Report are registered in
regional HIE system
Management of semantics
The final countdown
3
2
1
GO!
data sharing and
data aggregation from many sources
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The numbers
23 Laboratories
> 50 professionals involved
20 hours per month
of activities per person
2.5 years project period
5 FTE !
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The results
1,150 laboratory tests
15,168 local test results
4,046 LOINC
®
codes
2016
2017
2018
22 %
6 %
16 % of IMPROPER TRANSCODING
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local test codes ambiguous
...difficulties in quality check activity
...but laboratories had the chance to revise
configuration of their LISs system
different level of granularity between local and
LOINC
®
codes
...introduction of other standard code systems
“terminology service” manages only the mapping of
LOINC
®
Lab codes
...for our purpose it’s ok, but!
Barriers and taken solutions
during the project
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...the positive experience could be reused in other healthcare
domains.
improving of “Terminology Service” using CTS2
TM
Standard
...to grow the level of interoperability in semantics management
improving of “Terminology Service” with semi-automatic methods and
machine learning algorithms
...to ease mapping and quality check activity
...to support transcoding versioning and maintenance
“Terminology Service” integration with LIS
… to have a non-stop updating of codes in produced documents
...and
some suggestions for the future
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fundamental initial training phase and a constant
engagement of the clinicians
...fully gain the quality and efficiency
...to form a cohesive working team that can be
involved in other projects
have a skillful team
...schedules activities and
performs quality check analysis of transcoding
knowledge of shared clinical information power
...to growing the semantic enrichment and the high
quality of data
Recommendations
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From codes to “big data”
Veneto Region
interoperable system
readable and processable data
volume, velocity, variety, veracity, value
can be used as…
28,000 Laboratory Report per day
6,500,000 Laboratory Report accessible to be processed
...to improve medical
research and
clinical governance!
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Microbiology Lab Report:
biosurveillance system
antimicrobial resistance studies (AMR)
...go to see Session #311 on February, 15 at 12AM !
Stratification of Clinical Report
based on specific geographic areas:
Adjusted Clinical Groups (ACG)
prevention programs
Machine-learning algorithm
based on lab report results:
Prediction of renal function
...what else?
Applications
and new challenges
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Questions
Arianna Cocchiglia
R&D Manager
Consorzio Arsenàl.IT
acocchiglia@consorzioarsenal.it
@Consorz_Arsenal
LinkedIn: Consorzio Arsenàl.IT - OFFICIAL
Myriam Ferrari
Project Engineer
Consorzio Arsenàl.IT
mferrari@consorzioarsenal.it
@Consorz_Arsenal
LinkedIn: Consorzio Arsenàl.IT - OFFICIAL